COVID-19 infections among infants: Symptoms and who gets hospitalized

Posted on by Jesse Santiano, M.D.

The Canadian study Clinical manifestations and disease severity of SARS-CoV-2 infection among infants in Canada focused on infants who get COVID-19. They want to know their symptoms, how many are hospitalized, and the risk factors for severe COVID-19 among babies.

The study is from The Hospital for Sick Children in Toronto, Canada, in collaboration with other institutions in Canada and France. It was just published as a preprint in medRxiv and not yet peer-reviewed. It is the most extensive study of infants with COVID-19 to date.

They studied 531 infants (babies less than one-year-old) with COVID-19 reported to the Canadian Paediatric Surveillance Program (CPSP) from April 8, 2020, to May 31, 2021. 

How did the infants get their COVID-19?

Most infants had known close contact with a confirmed case of SARS-CoV-2 infection (58.5%) with either their

  1. Parents (79.2%)
  2. Siblings (14.7%)
  3. Other relatives (16.4%)
  4. Non-family members (4.2%).
What are the symptoms of COVID-19 in infants?

66 out of 531 (12.4%) were asymptomatic. The most common presenting symptoms are:

  • Fever (66.5%)
  • Coryza or runny nose (47.1%)
  • Cough (37.3%)
  • Poor appetite (25.0%)
What’s the percentage of infants with COVID-19 who get hospitalized?
  • 332 (62.5%) infants were managed as an outpatient
  • 199 (37.5%) were hospitalize . But not all of them are due to COVID-19
    • 141 of 199 infants (70.9%) were admitted because of COVID-19-related illness
    • 58 (29.1%) were hospitalized for reasons other than acute COVID-19.
  • Twenty of them (3.8%) met the criteria for severe disease. 
Hospitalization by age
  • Neonates (<1 month) were more likely to be hospitalized for COVID-19 than infants aged 1-3 months.
  • Infants aged 4-6 months and 7-12 months were less likely to be admitted than infants aged 1-3 months. 
By Ernest F – Own work, CC BY-SA 3.0,
Who among the infants with COVID-19 get hospitalized?

Infants with a comorbid condition had a higher chance of hospitalization than infants with no comorbid conditions, and infants less than a month old had higher odds of hospitalization than infants aged 1-3 months.

A premature infant born before 34 weeks of gestation has an increased odds of being hospitalized for COVID-19 than infants born at term.

Severe disease is uncommon. Only 20 infants out of 531 (3.8%) met the criteria for severe disease.

Comorbid conditions that increase the risk of hospitalizations
  • Congenital heart disease (20/531, 3.8%)
  • Neurologic or neurodevelopmental problems (19/531, 3.6%)
  • Chronic lung disease (10/531, 1.9%)
  • Fourteen infants (25/531, 2.6%) had more than one comorbidity
Disease severity among hospitalized infants
  • Mild illness in 111 of 141 infants (78.7%) 
  • Moderate disease in 10/141 (7.1%) 
  • Severe infection in 20 out of 141 (14.2%) 
Disease course among infants with severe COVID-10
  • Fewer than five infants with COVID-19 died
  • Fourteen infants out of 141 hospitalized (9.9%) were admitted to the Intensive Care Unit
    • <5 infants required non-invasive ventilation 
    • Five infants needed mechanical ventilation
  • A higher proportion of neonates aged <1 month (26.5%) admitted for COVID-19 required respiratory support (oxygen, non-invasive ventilation, and mechanical ventilation) compared to infants aged 1-12 months (11.0%)
How were the infants with COVID-19 managed medically?
  • Almost all infants managed as outpatients (314 of 332, 94.6%) did not receive any treatment
  • 61 out of 141 hospitalized (43.3%) of infants hospitalized for COVID-19 did not receive any treatment 
  • Antibiotics were the most frequent treatment modality (94/473, 19.9%)
    •  Neonates aged <1 month received antibiotics more frequently (35/69, 47.7%) than infants aged 1-3 months (34/138, 24.6%) and infants aged 4-12 months (25/262, 9.5%)
    • Only a few infants received systemic corticosteroids (11/473, 2.3%), including seven infants who received steroids for a non-COVID-19 related reason (for example, laryngitis. Less than five infants (<1.1%) received remdesivir.  
Variants of concern

This study was done before June 2021, when the Delta and Omicron variants were not yet around. However, no variants of concern were associated with an increased odds of hospitalization among infants. No phase of the pandemic (first, second or third wave) was associated with an increased odds of hospitalization in infants.

Summary

Severe COVID-19 is uncommon in infants. However, infants less than one-month-old and those with comorbidities have a higher risk for hospitalization.

 

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Related:

  1. COVID-19 during pregnancy follows a routine clinical course for the mother and her baby
  2. COVID-19 infections among infants: Symptoms and who gets hospitalized
  3. USA study: Adults and children with the Omicron variant have milder COVID-19
  4. COVID-19 in children 0-17 years old have low risk of death and hospitalization
  5. Children 5-11 Years Old have Mild COVID-19
  6. T cells from prior coronavirus protect and nucleocapsid directed COVID-19 shots may work better
  7. Asymptomatic or mild symptomatic COVID-19 elicits effective and long-lasting antibody responses in children and adolescents

Reference:

Pierre-Philippe Piche-Renaud, Luc Panetta, Daniel S. Farrar, Charlotte Moore-Hepburn, Olivier Drouin, Jesse Papenburg, Marina I. Salvadori, Fatima Kakkar, Shaun K. Morris. Clinical manifestations and disease severity of SARS-CoV-2 infection among infants in Canada. medRxiv 2022.02.02.22270334